{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T17:21:54Z","timestamp":1790270514678,"version":"4.1.0"},"reference-count":40,"publisher":"The Korean Spinal Neurosurgery Society","issue":"3","license":[{"start":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T00:00:00Z","timestamp":1785456000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/3.0\/"}],"content-domain":{"domain":["e-neurospine.org"],"crossmark-restriction":true},"short-container-title":["NS"],"published-print":{"date-parts":[[2026,7,31]]},"abstract":"<jats:p>Objective: Adjacent segment disease (ASD) is a recognized long-term complication after anterior cervical discectomy and fusion (ACDF). Cervical disc arthroplasty (CDA) was introduced as a motion-preserving alternative, thought to reduce stress at adjacent levels and lower ASD risk. This study aimed to compare the risk of ASD requiring reoperation after ACDF and CDA and identify factors associated with ASD.Methods: This retrospective cohort study used prospectively collected data from the Swedish Spine Registry (Swespine) and included adult patients undergoing anterior cervical surgery for degenerative cervical disease between 2006 and 2026. ASD was defined as a secondary operation at an adjacent level \u226512 months after the index procedure. Cumulative incidence was estimated using Kaplan-Meier analysis, and associations with ASD were evaluated using multivariable Cox proportional hazards regression. Radiological or conservatively treated ASD were not assessed.Results: A total of 9,338 patients were included (ACDF, n=9,005; CDA, n=333). During 45,666 person-years follow-up, 509 ASD events occurred (incidence rate 11.1 per 1,000 person-years). Cumulative incidence was 4.9% at 5 years and 10.4% at 10 years. CDA was associated with lower ASD hazard than ACDF (hazard ratio [HR], 0.61) though this association was not significant after propensity score matching (HR, 0.88). Multilevel procedures (HR, 0.61), increasing age (HR, 0.96 per year), and radiculopathy were associated with lower risk, while myelopathy or stenosis was associated with higher risk (HR, 1.22).Conclusion: The long-term risk of ASD requiring reoperation was lower than previously reported. After adjustment, CDA was associated with lower ASD risk compared to ACDF, although the absolute difference was small, and the clinical significance remains uncertain.<\/jats:p>","DOI":"10.14245\/ns.26520482.0241","type":"journal-article","created":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T09:15:42Z","timestamp":1785402942000},"page":"526-535","update-policy":"https:\/\/doi.org\/10.14245\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["A Nationwide Registry Study Comparing Long-term Risk of Adjacent Segment Disease Requiring Reoperation Following Anterior Cervical Discectomy and Fusion Versus Cervical Disc Arthroplasty"],"prefix":"10.14245","volume":"23","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-9192-1651","authenticated-orcid":true,"given":"Zehra","family":"Nazar","sequence":"first","affiliation":[{"name":"Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9479-761X","authenticated-orcid":true,"given":"Victor Gabriel","family":"El-Hajj","sequence":"additional","affiliation":[{"name":"Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8781-1169","authenticated-orcid":true,"given":"Erik","family":"Edstr\u00f6m","sequence":"additional","affiliation":[{"name":"Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden"},{"name":"Capio Spine Center Stockholm, L\u00f6wenstr\u00f6mska Hospital, Upplands-V\u00e4sby, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3776-6136","authenticated-orcid":true,"given":"Adrian","family":"Elmi-Terander","sequence":"additional","affiliation":[{"name":"Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden"},{"name":"Capio Spine Center Stockholm, L\u00f6wenstr\u00f6mska Hospital, Upplands-V\u00e4sby, Sweden"},{"name":"Department of Medical Sciences, \u00d6rebro University, \u00d6rebro, Sweden"},{"name":"Department of Surgical Sciences, Uppsala University, Uppsala, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1039-2098","authenticated-orcid":true,"given":"Victor Egon","family":"Staartjes","sequence":"additional","affiliation":[{"name":"Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden"},{"name":"Capio Spine Center Stockholm, L\u00f6wenstr\u00f6mska Hospital, Upplands-V\u00e4sby, Sweden"},{"name":"Machine Intelligence in Clinical Neuroscience & Microsurgical Neuroanatomy (MICN) Laboratory, Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"5355","reference":[{"key":"ref1","doi-asserted-by":"publisher","DOI":"10.3171\/2009.3.spine08720","type":"journal-article"},{"key":"ref2","doi-asserted-by":"publisher","DOI":"10.2106\/jbjs.st.15.00056","type":"journal-article"},{"key":"ref3","doi-asserted-by":"publisher","DOI":"10.2106\/00004623-199904000-00009","type":"journal-article"},{"key":"ref4","doi-asserted-by":"publisher","DOI":"10.3171\/spi-07\/09\/336","type":"journal-article"},{"key":"ref5","doi-asserted-by":"publisher","DOI":"10.1097\/00007632-200211150-00003","type":"journal-article"},{"key":"ref6","doi-asserted-by":"publisher","DOI":"10.1016\/j.jocn.2013.02.039","type":"journal-article"},{"key":"ref7","doi-asserted-by":"publisher","DOI":"10.1007\/s00586-020-06615-0","type":"journal-article"},{"key":"ref8","first-page":"e4171","type":"journal-article","volume-title":"Prevalence of adjacent segment disease following cervical spine surgery: a PRISMA-compliant systematic review and meta-analysis","author":"Kong","year":"2016"},{"key":"ref9","first-page":"2253","type":"journal-article","volume-title":"Rate of adjacent segment disease in cervical disc arthroplasty versus singlelevel fusion: meta-analysis of prospective studies","author":"Verma","year":"2013"},{"key":"ref10","doi-asserted-by":"publisher","DOI":"10.1097\/00024720-200404000-00001","type":"journal-article"},{"key":"ref11","first-page":"207","type":"journal-article","volume-title":"Anterior cervical discectomy and fusion outcomes over 10 years: a prospective study","author":"Buttermann","year":"2018"},{"key":"ref12","first-page":"721","type":"journal-article","volume-title":"Index and adjacent level kinematics after cervical disc replacement and anterior fusion: in vivo quantitative radiographic analysis","author":"Park","year":"2011"},{"key":"ref13","doi-asserted-by":"publisher","DOI":"10.1016\/j.spinee.2022.11.006","type":"journal-article"},{"key":"ref14","doi-asserted-by":"publisher","DOI":"10.1186\/s12883-020-01717-0","type":"journal-article"},{"key":"ref15","doi-asserted-by":"publisher","DOI":"10.1007\/s00586-013-2758-9","type":"journal-article"},{"key":"ref16","doi-asserted-by":"publisher","DOI":"10.1016\/j.spinee.2023.04.014","type":"journal-article"},{"key":"ref17","doi-asserted-by":"publisher","DOI":"10.1016\/j.spinee.2024.10.010","type":"journal-article"},{"key":"ref18","doi-asserted-by":"publisher","DOI":"10.1016\/j.apmr.2024.01.021","type":"journal-article"},{"key":"ref19","doi-asserted-by":"publisher","DOI":"10.4103\/sja.sja_543_18","type":"journal-article"},{"key":"ref20","volume-title":"Uppf\u00f6ljning AV Ryggkirurgi Utf\u00f6rd I Sverige \u00c5R 2019","author":"Fritzell","year":"2019","type":"other"},{"key":"ref21","doi-asserted-by":"publisher","DOI":"10.1007\/s00586-025-09455-y","type":"journal-article"},{"key":"ref22","first-page":"319","type":"journal-article","volume-title":"A nationwide registry study of surgical and patient-reported outcomes following anterior cervical discectomy and fusion: Part 2 - cage with versus without local bone graft","author":"de Wilde","year":"2025"},{"key":"ref23","volume-title":"","author":"Hosmer","year":"2013","type":"book"},{"key":"ref24","doi-asserted-by":"publisher","DOI":"10.1186\/1751-0473-3-17","type":"journal-article"},{"key":"ref25","first-page":"597","type":"journal-article","volume-title":"Prevalence of adjacent segment degeneration after spine surgery: a systematic review and meta-analysis","author":"Xia","year":"2013"},{"key":"ref26","doi-asserted-by":"publisher","DOI":"10.1227\/neu.0b013e318232d4f2","type":"journal-article"},{"key":"ref27","first-page":"1761","type":"journal-article","volume-title":"Risk-factor analysis of adjacent-segment pathology requiring surgery following anterior, posterior, fusion, and nonfusion cervical spine operations: survivorship analysis of 1,358 patients","author":"Lee","year":"2014"},{"key":"ref28","doi-asserted-by":"publisher","DOI":"10.1186\/s13018-025-06189-x","type":"journal-article"},{"key":"ref29","first-page":"192","type":"journal-article","volume-title":"Mid-term to longterm outcomes after total cervical disk arthroplasty compared with anterior diskectomy and fusion: a systematic review and meta-analysis of randomized controlled trials","author":"Byvaltsev","year":"2020"},{"key":"ref30","doi-asserted-by":"publisher","DOI":"10.3171\/2021.9.spine21904","type":"journal-article"},{"key":"ref31","doi-asserted-by":"publisher","DOI":"10.14444\/7086","type":"journal-article"},{"key":"ref32","doi-asserted-by":"publisher","DOI":"10.1177\/21925682251325823","type":"journal-article"},{"key":"ref33","doi-asserted-by":"publisher","DOI":"10.1016\/j.spinee.2015.02.039","type":"journal-article"},{"key":"ref34","doi-asserted-by":"publisher","DOI":"10.1177\/2192568217719436","type":"journal-article"},{"key":"ref35","doi-asserted-by":"publisher","DOI":"10.1016\/j.xnsj.2023.100305","type":"journal-article"},{"key":"ref36","doi-asserted-by":"publisher","DOI":"10.1016\/j.spinee.2004.04.011","type":"journal-article"},{"key":"ref37","doi-asserted-by":"publisher","DOI":"10.1007\/s00701-022-05453-x","type":"journal-article"},{"key":"ref38","doi-asserted-by":"publisher","DOI":"10.1007\/s00586-015-4127-3","type":"journal-article"},{"key":"ref39","doi-asserted-by":"publisher","DOI":"10.1007\/s00586-019-06181-0","type":"journal-article"},{"key":"ref40","doi-asserted-by":"publisher","DOI":"10.3109\/17453674.2010.548024","type":"journal-article"}],"container-title":["Neurospine"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/e-neurospine.org\/upload\/pdf\/ns-26520482-0241.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/e-neurospine.org\/journal\/view.php?doi=10.14245\/ns.26520482.0241","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/e-neurospine.org\/upload\/pdf\/ns-26520482-0241.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T04:54:14Z","timestamp":1786510454000},"score":1,"resource":{"primary":{"URL":"http:\/\/e-neurospine.org\/journal\/view.php?doi=10.14245\/ns.26520482.0241"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,31]]},"references-count":40,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2026,7]]}},"URL":"https:\/\/doi.org\/10.14245\/ns.26520482.0241","relation":{},"ISSN":["2586-6583","2586-6591"],"issn-type":[{"value":"2586-6583","type":"print"},{"value":"2586-6591","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,31]]},"assertion":[{"value":"2026-03-21","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-05-17","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-31","order":2,"name":"published","label":"Published online","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-31","order":3,"name":"published","label":"Print publication","group":{"name":"publication_history","label":"Publication History"}}]}}